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In agreement: Neha Sangwan on the importance of clear communication

_JK_0412Here's the scenario, Neha Sangwan, MD, a medical and personal communications consultant, told a rapt Medicine X | ED audience Saturday afternoon.

She was addressing the operating room staff of a hospital. The staff's troubles, stemming from a dysfunctional culture plagued by power struggles and gossip, had led to errors involving patients — and something needed to change.

So Sangwan, who goes by Doctor Neha, agreed to address the group. She welcomed audience participation during her presentations so she said she wasn't surprised when a 50-something anesthesiologist with stylish round glasses stood up.

"These communication tools you are teaching us are nice and all," he said. "But I'm just wondering how they are going to make the staff around here more competent."

Silence and shock reverberated around the room.

Sangwan said she paused, taking a deep breath and a moment to figure out how to respond to the provocative question. She asked the anesthesiologist to explain, and he did: When he yelled that he needed "two units of blood stat" while in the operating room, nothing happened. No blood appeared.

"I started to understand that what was at the root of what he was asking was missed expectations and broken trust. This had clearly been going on for a little while," Sangwan told the audience.

The anesthesiologist thought he was communicating, but there was no recipient and his words alone didn't create a shared understanding that led to action.

The trick, Sangwan said, is to understand the nature of agreements. Agreements, ranging from something as simple as going to the movie with a friend to an agreement to take a new job, have five levels, characterized by the responses to a question, she said:

  1. Acknowledgement (a response of any sort, letting the speaker know he or she was heard)
  2. Expressing positive interest (in the request for blood example, a response like "That's a good idea")
  3. Qualified yes ("Yes, but I need to go on break now and am busy")
  4. Clear yes ("Yes" without making any moves to obtain the blood)
  5. Confirming the details ("Yes, I will get the blood right now.")

To ensure action, a level five agreement is needed, Sangwan said. In that light, the anesthesiologist had received not even the most basic of agreements — no one had answered him.

The levels of agreement can be applied to improve personal and professional relationships, Sangwan said, asking the Med X crowd to consider the levels of communication they expect and give to others, as well as to themselves.

"Agreements matter. They matter in your everyday lives and in your personal lives and satisfaction and they really matter on how we work together and whether or not together we will heal," she emphasized.

Previously: Medicine X | ED happening this weekendWorking together in health care: Why it's hard and what worksOn learning, the patient's voice and the power of stories: Stanford's Medicine X | ED begins and Improving communication in health care: A preview of Med X | ED,
Photo courtesy of Stanford Medicine X

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